The Effect of an Implantable Doppler Probe on the Salvage of Microvascular Tissue Transplants

Kind, Gabriel M.; Buntic, Rudolf F.; Buncke, Gregory M.; Cooper, Timothy M.; Siko, Peter P.; Buncke, Harry J.

doi:10.1097/00006534-199804050-00016

Cited by 56 publications

(80 citation statements)

References 11 publications

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“…2B). When we removed Kind et al 9 and Ferguson and Yu, 20 the 2 moderate-quality studies, the I 2 was 0%, and the flap failure rate still had significant difference between the groups (RR: 0.38; 95% CI: 0.22–0.65) (Fig. 2C).…”

Section: Resultsmentioning

confidence: 98%

“…Based on our specified exclusion criteria, the texts of 22 articles were assessed for eligibility. Eight comparative observational studies 9,16–20,24,25 met the inclusion criteria. Because Rozen et al 17 and Whitaker et al 24 shared some patients, the latter was excluded.…”

Section: Resultsmentioning

confidence: 99%

“…Because Ho et al 25 selected their patients using specified criteria rather than consecutively, it, too, was excluded. Finally, 6 articles 9,16–20 were included in a quantitative synthesis (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…Smit et al 19 monitored 8 flaps by flap type and defect location; the other 2 studies 16,17 monitored 7 consecutive flaps each. Kind et al 9 did not mention whether the flaps were from consecutive cases, but they did say that the control group contained patients clinically monitored before the implantable Doppler probe had been introduced. The NOS score for Smit et al 19 was 6.…”

Section: Resultsmentioning

confidence: 99%

“…14,15 Moreover, using it to monitor free tissue transfer yields inconclusive results. 9,16–20 Only one systematic review 21 focuses on the cost-effectiveness of the system.…”

mentioning

confidence: 99%

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Implantable Doppler Probes for Postoperatively Monitoring Free Flaps: Efficacy. A Systematic Review and Meta-analysis

Chang

Lee

Lin

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Background:Although clinical assessment remains the gold standard for monitoring the circulation of free flaps, several adjunct techniques promote timely salvage by detecting circulation compromise early. The objective of this systematic review was to evaluate the efficacy of an implantable Doppler probe for postoperatively monitoring free flaps.Materials and Methods:English-language articles evaluating the efficacy of implantable Doppler probes compared with clinical assessment for postoperatively monitoring free flaps were analyzed. The outcome measures were total flap failure rates, salvage rates, sensitivity, false-positive rates, and positive likelihood ratios.Results:Of the 504 citations identified, 6 comparative studies were included for meta-analysis. An implantable Doppler probe significantly lowered the flap failure rate (risk ratio: 0.40; 95% confidence interval: 0.21–0.75) and raised the successful salvage rate (risk ratio: 1.73; 95% confidence interval: 1.16–2.59). Pooled sensitivity was higher (1.00 vs 0.98), the positive likelihood ratio was lower (72.16 vs 220.48), and the false-positive rate was higher (0.01 vs 0) in the implantable Doppler probe group than in the clinical assessment group.Conclusion:An implantable Doppler probe is significantly more efficacious than clinical assessment for postoperatively monitoring free flaps.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…14,15 Moreover, using it to monitor free tissue transfer yields inconclusive results. 9,16–20 Only one systematic review 21 focuses on the cost-effectiveness of the system.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Implantable Doppler Probes for Postoperatively Monitoring Free Flaps: Efficacy. A Systematic Review and Meta-analysis

Chang

Lee

Lin

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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The Implantable Cook-Swartz Doppler Probe for Postoperative Monitoring in Head and Neck Free Flap Reconstruction

Guillemaud¹,

Seikaly²,

Côté³

et al. 2008

Arch Otolaryngol Head Neck Surg

102

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Patients: A consecutive series of 351 patients (244 men and 107 women; mean age, 58.63 years) who underwent free flap reconstruction of head and neck defects that were monitored using the implantable Doppler probe were included. Results: The most common indication for surgery was squamous cell carcinoma (81.0%), followed by functional reconstruction (4.3%). The most common free flap used was radial forearm (68.0%), followed by the fibular free flap (19.0%). With operative exploration used as the gold standard, the Cook-Swartz Doppler Flow Monitoring System had a sensitivity of 65.8% and specificity of 98.2% for the detection of flap compromise. For the detection of vascular compromise of the monitored vessel (excluding flap compromise cases whereby flow in the monitored vessel was not compromised on operative exploration, ie, venous obstruction, hematoma formation, and necrotizing fasciitis), the sensitivity increased to 100%. Conclusions: This is the largest reported series, to our knowledge, of implantable Cook-Swartz Doppler use, and our experience would suggest that this is a reliable technique for postoperative monitoring in head and neck reconstruction. Our use of the implantable Doppler probe allowed us to recognize vascular compromise early, resulting in an overall flap success rate of 98.1%, with a 92.0% salvage rate of flaps that experienced vascular compromise of the monitored vessel.

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Analysis of 49 cases of flap compromise in 1310 free flaps for head and neck reconstruction

et al. 2008

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Background. The purpose of this study was to analyze the causes of flap compromise and failure in head and neck free flap reconstruction.Methods. We retrospectively reviewed 1310 free flap reconstructions for head and neck defects performed between July 1995 and June 2006.Results. Forty-nine cases of flap compromise due to vascular obstruction (3.7%) were identified, and 27 flaps were lost (2%). Arterial occlusions occurred in 12 flaps, with a salvage rate of 33%. Eight flaps failed within the first 24 hours, and only 1 of these was salvageable. Five of the 8 flaps had intraoperative thrombosis due to technical difficulties. Venous occlusions occurred in 31 flaps, with a salvage rate of 58%. Twenty-two venous occlusions occurred within the first 72 hours. The main reason for venous failure was mechanical obstruction due to compression, twisting, kinking, or stretching of the vein. The most common cause of late failures (after 7 days) was unrecognized failure of a buried flap owing to the lack of reliable monitoring. Overall, there was no correlation between surgeon experience and flap failure, but the flap failure rate was lower in surgeons who had performed more than 70 free flap procedures.Conclusion. Precise surgical techniques, avoidance of mechanical obstruction, and better monitoring of buried flaps may further improve the success rate of free tissue transfer in complex head and neck reconstruction. Free flap reconstruction has become an integral part of the multidisciplinary care of head and neck cancers in most major medical centers. The success rates for microsurgical procedures have greatly improved over the past few decades. Many centers have reported free flap success rates greater than 96%, and in some expert hands, close to 99%, 1-9 making this operation 1 of the most reliable procedures in reconstructive surgery. 1 However, flap crises and failures do occur occasionally, and most reports seem to show that free flap failure occurs more frequently in head and neck reconstruction than in breast reconstruction. 1,5,7,8 Early reports suggested that operator experience was the most important factor responsible for the success of free flap reconstruction. [1][2][3][4][5] For example, the free flap success rate of 1 surgeon improved from about 70% in early cases to greater than 96% in later cases. [1][2][3] This may reflect the early self-learning and trial and error experience. However, with current well-established microsurgery centers, standards, and training, many

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The Effect of an Implantable Doppler Probe on the Salvage of Microvascular Tissue Transplants

Cited by 56 publications

References 11 publications

Implantable Doppler Probes for Postoperatively Monitoring Free Flaps: Efficacy. A Systematic Review and Meta-analysis

Implantable Doppler Probes for Postoperatively Monitoring Free Flaps: Efficacy. A Systematic Review and Meta-analysis

The Implantable Cook-Swartz Doppler Probe for Postoperative Monitoring in Head and Neck Free Flap Reconstruction

Analysis of 49 cases of flap compromise in 1310 free flaps for head and neck reconstruction

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